Implementation of Universal Postpartum Screening on a High‐Risk L&D Unit Specializing in Delivering Babies with Birth Defects

Objective: A postpartum mental health screening tool was implemented within a high‐risk obstetric unit to identify risks experienced among women giving birth to infants with confirmed fetal anomalies. Design: A universal screening protocol was implemented into standard postpartum care. Any woman indicating clinical risk was referred to the psychologist for further assessment to determine appropriate treatment and intervention. A cross‐sectional design was used to measure the prevalence of depression, anxiety, and traumatic stress risk reported among this population and further analyses were used to determine demographic factors and/or fetal diagnoses that correlated with greater postpartum mental health risk. Setting: The Garbose Family Special Delivery Unit (SDU) opened in 2008 as the first state‐of‐the‐art birthing facility located within a pediatric hospital. Each year approximately 300 to 400 pregnant women carrying fetuses with birth defects and/or complex medical and genetic conditions give birth in the SDU. Sample: During the 6‐month study period, 164 women completed a postpartum screening tool on Day 1 postdelivery. Methods: On postpartum Day 1, participants were asked to complete screening by their bedside nurses. Those women with clinically significant symptoms were referred to the clinical psychologist for additional triage and intervention prior to their SDU discharge. Results: A total of 164 women completed screening tools during the 6‐month study period. The majority of infants in the sample had congenital heart defects (42.1%), neurological defects (19.5%), and gastrointestinal anomalies (9.8%); 32.3% of mothers had clinically significant risk for postpartum depression symptoms, and 5.5% had symptoms of traumatic stress risk in response to seeing their infants for the first time in the intensive care unit (ICU). Conclusion/Implications for Nursing Practice: Findings demonstrated that standardized postpartum screening for women with fetuses with confirmed anomalies is paramount. The success of this screening tool is dependent on nurses’ commitment to presenting the tool in a standardized manner as part of routine postpartum care. The information received can assist rapid assessment and implementation of therapeutic interventions prior to a woman's SDU discharge. This could ultimately help promote effective coping skills to manage her emotional well‐being during the neonatal ICU hospitalization and mediate a possible exacerbation of psychological symptoms in the postpartum period.